Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

Abstract

Pelvic actinomycosis is an uncommon, slowly progressing granulomatous infection that has been associated with the presence of intrauterine devices. Due to its unspecific clinical and radiologic findings, it can mimic pelvic or intra-abdominal malignancy leading to mutilating surgery of high morbidity. Rarely, diagnosis is made preoperatively and in most cases surgical intervention is necessary. The patient in our case is a 42-year-old female with an IUD for 15 years diagnosed with pelvic actinomycosis. Patient was uniquely diagnosed preoperatively through paracentesis and treated conservatively with prolonged antibiotic therapy and without any type of surgical intervention. Follow-up at 1 year showed almost complete radiologic resolution of the inflammatory mass, nutritional recovery, and absence of symptoms. Pelvic actinomycosis can be successfully diagnosed and treated medically without surgical interventions.

The Pathogenic Role of Actinomyces spp. and Related Organisms in Genitourinary Infections: Discoveries in the New, Modern Diagnostic Era

“…In addition to the administration of antibiotics, surgical procedures should also be included in the therapeutic protocols associated with Actinomyces infections, whether to provide an adjunctive role in the healing process (in milder cases) or to ensure the possibility of clinical success (reducing the formation of scar tissue, abscess drainage, excision of necrotic tissue and fistulas) [1,12,37,[148][149][150]156]. Surgial intervention may have an additional benefit of reducing the duration and dose of antibiotic treatment required [1,12,37,[148][149][150]156,157]. Removal of the IUDs is crucial in patients with IUD-associated actinomycosis [158].…”

“…Open surgical resection, often required for the definite diagnosis of genitourinary tract actinomycosis, facilitates the cure, but may be mutilating, especially if hysterectomy or bladder resection is performed [159]. There are no extensive data on the duration of antimicrobial therapy in such patients, but the duration of antimicrobials should probably be reduced in patients with extensive surgical resection of a small genital mass [1,12,37,[148][149][150][156][157][158][159].…”